Normal Pressure Hydrocephalus as Cause of Urinary Incontinence – A Shunt for Incontinence

We report a case of a 46-year-old man presenting with a progressive cognitive decline, ataxic gait, urinary incontinence for 4 months and neuroimaging consistent with normal pressure hydrocephalus. The atypical presentation of a progressively worsening dysphasia and a right hemiparesis dismissed as a vascular event 1 month earlier associated with normal pressure hydrocephalus prompted further investigations confirming neurosyphilis also manifesting as dementia paralytica. Treatment using consensus guidelines led to resumption of activities of daily living. Neurosyphilis, considered rare in the neuroimaging era, must still be considered a reversible cause of dementia and other neurological manifestations in contemporary neurological practice.

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Normal-Pressure Hydrocephalus: Is There a Genetic Predisposition?

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710001146x ◽

2011 ◽

Vol 38 (2) ◽

pp. 274-281 ◽

Cited By ~ 18

Author(s):

M. D. Cusimano ◽

D. Rewilak ◽

D. T. Stuss ◽

J. C. Barrera-Martinez ◽

F. Salehi ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Urinary Incontinence ◽

Cognitive Impairment ◽

Environmental Factors ◽

Natural History ◽

Normal Pressure Hydrocephalus ◽

Genetic Predisposition ◽

Fluid Pressure ◽

Cerebral Atrophy ◽

Normal Pressure

Background:Normal-pressure hydrocephalus (NPH) is characterized by gait disturbance, cognitive impairment, with or without urinary incontinence, enlarged ventricles with or without cerebral atrophy and normal cerebrospinal fluid pressure.Methods:We report two sisters with NPH who lived together their entire lives and whose natural history might provide insights into genetic and environmental mechanisms underlying this disorder. Both patients were in their early seventies, single, had similar daily habits and hypertension. No other family members had NPH.Results:They both underwent shunt placement and showed improvement documented by history and neuropsychological assessment. Both showed a delayed deterioration due to vasculopathy. Both patients were homozygous for the apolipoprotein E (ApoE) e3 allele on chromosome 19. No environmental factors that might have influenced the development of NPH were identified.Conclusion:Our report of two sisters with NPH may indicate the presence of genetic predisposition and further studies involving genetics and environmental factors are necessary to elucidate their role in the pathogenesis of NPH.

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Faculty Opinions recommendation of Assessment of the urodynamic diagnosis in patients with urinary incontinence associated with normal pressure hydrocephalus.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718348898.793494372 ◽

2014 ◽

Author(s):

Francisco Cruz

Keyword(s):

Urinary Incontinence ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure

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Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar puncture.

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.51.1.105 ◽

1988 ◽

Vol 51 (1) ◽

pp. 105-108 ◽

Cited By ~ 51

Author(s):

J Ahlberg ◽

L Norlen ◽

C Blomstrand ◽

C Wikkelso

Keyword(s):

Urinary Incontinence ◽

Lumbar Puncture ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Shunt Operation

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Performance of the fixed pressure valve with antisiphon device SPHERA® in the treatment of normal pressure hydrocephalus and prevention of overdrainage

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150190 ◽

2015 ◽

Vol 74 (1) ◽

pp. 55-61 ◽

Cited By ~ 6

Author(s):

Renan M. Pereira ◽

Mariane T. Suguimoto ◽

Matheus F. Oliveira ◽

Juliana B. Tornai ◽

Ricardo A. Amaral ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Urinary Incontinence ◽

Clinical Improvement ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Antisiphon Device

ABSTRACT Normal pressure hydrocephalus (NPH) is characterized by the triad of gait apraxia, dementia and urinary incontinence associated with ventriculomegaly and normal pressure of cerebrospinal fluid. Treatment is accomplished through the implantation of a ventricular shunt (VPS), however some complications are still frequent, like overdrainage due to siphon effect. This study analyses the performance of a valve with anti-siphon device (SPHERA®) in the treatment of patients with NPH and compares it with another group of patients with NPH who underwent the same procedure without anti-siphon mechanism (PS Medical® valve). 30 patients were consecutively enrolled in two groups with 15 patients each and followed clinically and radiologically for 1 year. Patients submitted to VPS with SPHERA® valve had the same clinical improvement as patients submitted to VPS with PS Medical®. However, complications and symptomatology due to overdrainage were significantly lower in SPHERA® group, suggesting it as a safe tool to treat NPH.

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Ventriculosternal Shunt for the Treatment of Idiopathic Normal Pressure Hydrocephalus: A Case Report

Frontiers in Surgery ◽

10.3389/fsurg.2021.607417 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xinxia Guo ◽

Abdul Malik Popal ◽

Zhoule Zhu ◽

Chengwei Cai ◽

Jingquan Lin ◽

...

Keyword(s):

Urinary Incontinence ◽

Normal Pressure Hydrocephalus ◽

Abdominal Cavity ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Gait Disturbance ◽

Related Complication ◽

Csf Diversion ◽

Cardiac Doppler

Background: Conventional corticospinal fluid (CSF) diversion surgery for idiopathic normal pressure hydrocephalus (iNPH) includes ventriculoperitoneal shunt and ventriculoatrial shunt. Ventriculosternal (VS) shunt may be considered if both the abdominal cavity and atrium are not feasible.Methods: A 76-year-old woman was admitted to our hospital with gait disturbance and urinary incontinence for 2 years, and the condition aggravated in the last 1 month. Based on clinical assessment and imaging findings, the patient was diagnosed with iNPH, with surgical indications. She was on peritoneal dialysis for chronic renal failure, and a cardiac Doppler echocardiogram showed enlargement of the left atrium and decreased diastolic function of the left ventricle. Due to these conditions, we chose the sternum as the vessel for CSF absorption and performed VS shunt.Results: No swelling, exudation, and effusion were found in the suprasternal fossa. Gait disturbance and urinary incontinence improved significantly immediately and 1 week after surgery, respectively. No shunt-related complication was reported at 16 months follow-up.Conclusion: This case demonstrated VS shunting as a feasible and alternative for the management of hydrocephalus.

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